A lung transplant consists of replacing all or part of diseased lungs with healthy lung(s). Transplantation is an option for patients with end-stage lung disease.

End-stage lung disease may be the consequence of a number of different etiologies. The most common indications for lung transplantation are chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1 antitrypsin deficiency, and idiopathic pulmonary arterial hypertension. Prior to the consideration for transplant, patients should be receiving maximal medical therapy, including oxygen supplementation, or surgical options, such as lung-volume reduction surgery for COPD. Lung or lobar lung transplantation is an option for patients with end-stage lung disease despite these measures.

A lung transplant refers to single-lung or double-lung replacement. In a single-lung transplant, only one lung from a deceased donor is provided to the recipient. In a double-lung transplant,the recipient's lungs are removed and replaced by the donor's lungs.In a lobar transplant, a lobe of the donor’s lung is excised, sized appropriately for the recipient’s thoracic dimensions, and transplanted.Donors for lobar transplant have primarily been living-related donors, with one lobe obtained from each of 2 donors (eg, mother and father) in cases for which bilateral transplantation is required. There are also cases of cadaver lobe transplants. Combined lung-pancreatic islet cell transplant is being studied for patients with cystic fibrosis.

Since 2005, potential recipients have been ranked according to the Lung Allocation Score (LAS). Patients 12 years of age and older receive a score between 1 and 100 based on predicted survival after transplantation reduced by predicted survival on the waiting list; the LAS takes into consideration the patient’s disease and clinical parameters. In 2010, a simple priority system was implemented for children younger than age 12 years. Under this system, children younger than 12 years with respiratory lung failure and/or pulmonary hypertension who meet criteria are considered “priority 1” and all other candidates in the age group are considered “priority 2.” A lung review board has the authority to adjust scores on appeal for adults and children.

No benefits will be provided for a covered transplant procedure or a transplant evaluation unless the Member receives prior authorization through case management from Blue Cross & Blue Shield of Mississippi.

Lung transplantation may be consideredmedically necessary for carefully selected patients with irreversible, progressively disabling, end-stage pulmonary diseaseunresponsive to maximum medical therapy including, but not limited to one of the conditions listed below.

A lobar lung transplant from a living or deceased donor may be consideredmedically necessary for carefully selected patients with end-stage pulmonary disease including, but not limited to one of the conditions listed below:

Bilateral bronchiectasis

Alpha-1 antitrypsin deficiency

Primary pulmonary hypertension

Cystic fibrosis (both lungs to be transplanted)

Bronchopulmonary dysplasia

Postinflammatory pulmonary fibrosis

Idiopathic/interstitial pulmonary fibrosis

Sarcoidosis

Scleroderma

Lymphangiomyomatosis

Emphysema

Eosinophilic granuloma

Bronchiolitis obliterans

Recurrent pulmonary embolism

Pulmonary hypertension due to cardiac disease

Chronic obstructive pulmonary disease

Eisenmenger's syndrome

Lung or lobar lung retransplantation after a failed lung or lobar lung transplant may be considered medically necessary in patients who meet criteria for lung transplantation.

Lung or lobar lung transplantation is considered investigational in all other situations.

For Federal Employee Program (FEP) subscribers only, lung and lobar lung transplant may be considered medically necessary. (See FEP policy)

For State and School Employee subscribers, all transplants must be certified as medically necessary by the Plan’s Utilization Review Vendor. No benefits will be provided for any transplant procedure unless prior approval for the transplant is obtained.

02/23/2011: Policy statement and guidelines updated to include specific contraindications for lung transplant.

02/24/2012: Deleted outdated references from the Sources section. Contraindications moved to the Policy Guidelines section, and the absolute and relative contraindications were combined. Deleted outdated references from the Sources section.

09/16/2014: Policy reviewed; description updated. First medically necessary statement revised to state that lung transplantation may be consideredmedically necessary for carefully selected patients with irreversible, progressively disabling, end-stage pulmonary disease unresponsive to maximum medical therapy.Lobar policy statement revised to add that transplant may be from a living or deceased donor. Lobar policy statement list of conditions revised to remove pulmonary fibrosis and emphysematous bleb; added postinflammatory pulmonary fibrosis. Added the following policy statements: 1) Lung or lobar lung retransplantation after a failed lung or lobar lung transplant may be considered medically necessary in patients who meet criteria for lung transplantation. 2) Lung or lobar lung transplantation is considered investigational in all other situations.

02/16/2015: Policy description and statement unchanged. Policy guidelines updated to add "Policy-specific" to the list of potential contraindications subject to the judgment of the transplant center.

Solid organ(s), complete or segmental, single organ or combination of organs; deceased or living donor(s), procurements, transplantation, and related complications including: drugs; supplies; hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre-and post-transplant care in the global definition